Insurance Coverage for Autism Spectrum Disorder in Pennsylvania

If you or someone you know is the parent of a child with autism, you need to know about a
new law that will change the way your child's autism-related services are covered. This Act
will make changes to the way that autism services are covered through the
Medical Assistance
program and private health insurers.

The Autism Insurance Act:

Requires many private health insurance companies to cover the cost of diagnostic assessment and treatment of autism spectrum disorder and services for children under the age of 21, up to $36,000 per year;

Diagnostic assessment and treatment of autism spectrum disorders, which include:

Prescription drugs and blood level tests;

Services of a psychiatrist and/or psychologist (direct or consultation);

Applied behavioral analysis; and

Other rehabilitative care and therapies, such as speech and language pathologists, occupational and physical therapists.

Treatment Requirements:

Must be for an autism spectrum disorder;

Must be medically necessary;

Must be identified in a treatment plan;

Must be prescribed, ordered or provided by a licensed physician, licensed physician assistant, licensed psychologist, licensed clinical social worker or certified registered nurse practitioner; and

Must be provided by an autism service provider or a person, entity or group that works under the direction of an autism service provider.

For additional information and resources for families, insurers and providers as well as answers to Frequently Asked Questions, www.PAAutismInsurance.org. If you have a more specific question or need more clarification about the Autism Insurance Act, email your questions to ra-in-autism@state.pa.us.

About Autism Spectrum Disorders

Autism is a brain-based neurological condition that is usually diagnosed by the time a child is three years old. Children who are diagnosed need intervention as soon as possible. With the right kinds of supports, individuals can make substantive progress. For more information about autism, visit www.autisminpa.org.